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Published: June 6, 2019

Chronic Prostatitis and Chronic Pelvic Pain Syndrome(CPPS)

CPPS remains a very common yet poorly understood disease with hardly any solid therapeutic options based on level 1 evidence. It affects around 50% of men throughout their lifetime and can cause urinary and erectile dysfunction if left untreated affecting their quality of life. Currently, there is a lack of guidelines for the management of CPPS.

Treatment options have remained the same for many years with no new non invasive therapy offered in most parts of the world. Treatment centre around the 3A concept which means that doctors will try either using one or all 3 of the A’S which are medications. The A’s are Analgesia(Pain killers), Antibiotics and Alpha blockers(muscle relaxants for prostate smooth muscles). Depending on the clinical assessment and your symptoms you will be categorised broadly into inflammatory or non inflammatory prostatitis and the medication cocktail is then decided. Along with this treatment you may be offered a prostatic massage which can be very unpleasant. (Summary of the Europena Association of Urology guidelines 2019) Chronic pelvic pain is a clinical condition that results from the complex interactions of physiological and psychological factors and has a direct impact on the social, marital and professional lives of men and women.

In Men Chronic pain and its treatment can impair our ability to express sexuality. In a study in England, 73% of patients with chronic pain had some degree of sexual problems as result of the pain. These problems can occur because of several factors:

-Psychological factors like decrease in self-esteem, depression and anxiety can contribute to loss of libido.
-Physiological factors like fatigue, nausea and pain itself can cause sexual dysfunction.
-Pain medications (opioids, and the selective serotonin re-uptake inhibitors [SSRIs]) can also decrease libido and delay ejaculation. The number of studies on the effects of CPP on sexual function is unfortunately limited. Sexual dysfunction is often ignored because of a lack of standardised measurements. At present, the most commonly used tool is the IIEF questionnaire.The presence of pelvic pain may increase the risk for ED independent of age.

Although mental distress and impaired QoL related to illness could contribute to sexual
dysfunction observed in patients with PPS, the presence of erectile and ejaculatory disorders is more frequently related to symptoms suggestive of a more severe inflammatory condition. These arguments are important for the understanding of the close relationship between CPP symptoms, disturbed sexuality, impact on QoL, and psychological implications including depression and more failure anticipation thoughts. Sexual dysfunction heightens anger, frustration and depression, all of which place a strain on the patients’ relationships.

Men with CPP have reported a high frequency of sexual relationship dissolution and psychological symptoms, such as depression and suicidal thinking. So it is but obvious this is an important condition to manage and managed well it must. We have been handicapped with the lack of solid consensus on what is the best way to treat this
condition and at times resort to trying to ‘brush’ it off by trying to convince the patient that its not a
serious problem and maybe they should just forget about it. That of course never happens and the patient simply will start shopping around for other opinions and at times resort to unconventional, unsafe methods to self help.

I have taken special interest in this and have now developed a successful treatment strategy. I use a combination of medications,short term, and treat CPPS, PPS and Chronic prostatitis with

Extracorporeal shock wave therapy. As you can see in the chart below the treatment is evidence based. There is no doubt about it working in the short term but the question is how will patients fair in the long term. In my experience with more then 300 patients over the past 3 years the effect seems to last more then 12 months in the majority of patients. Of course my data may be considered anecdotal because I have no randomised controlled study to carry my numbers however I am convinced enough that this safe treatment should be offered to every patient with theses symptoms.

This new revolutionary treatment option helps the prostate repair itself by stimulating it to release endogenous stem cells and can lead to tissue repair and regeneration. Shock wave therapy is already an accepted form of treatment for Erectile dysfunction so we know and are certain of the following:

1) Safe to use with no reported side effects
2) Ability to stimulate the release of endogenous stem cels which have anti-inflammatory response and cause tissue repair.
3) A very high success rate based on the literature already available
4) A cheaper and much safer option before considering more invasive therapies like
surgery etc.

We are the 1st and currently the only centre offering this treatment in Malaysia and have found it to have many other therapeutic indications.


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